Written by a CuraCore Veterinary Medical Acupuncture course graduate. Signed release obtained from client/author. 10D2018023
Abstract: Kasey is a 14 year old dog that has been having weakness and stiffness for the past year. I used dry needling acupuncture and laser therapy on Kasey and she has had a great response. Ultimately, electroacupuncture will be the next step with Kasey to try to continue to decrease the tightness of her trigger points in the cervical region.
History: Kasey is a 14 year old dog that is starting to experience some weakness in her hind limbs. Her owners report that she seems to be having a harder time getting up in the hind-end after laying down. She also cannot run up the stairs like she used to be able to or she falls down. When laying down Kasey slowly starts to lay down until her hind end gives out and she just plops down to the ground. She has a history of having a blood clot on her spleen, so she takes daily aspirin to prevent further blood clots from forming. Within the last year, Kasey seems to have developed a moaning sound that she does every now and then while laying down.
Current medications: Galiprant 50mg PO SID, Gabapentin 200mg PO BID, Aspirin 20mg PO SID, probiotic, glucosamine, and omega supplement.
Examination and Assessment:
My first assessment of Kasey was performed on 1/20/2019. While walking Kasey has very mild kyphosis along the lumbar region. She also is a little slow with her hind limbs while walking and occasionally drags her toes. Kasey is very slow to lay down and has more of a plop down in the hind end rather than a nice and controlled movement to the floor.
Myofascial palpation revealed mild sensitivity over the cervical region and the myofascia was very tense and only slightly moveable throughout the lumbar and sacral regions. Deeper palpation of the muscles revealed mild tension of the cervical musculature, with a trigger point in the splenius bilaterally. She had significant muscle atrophy bilaterally in the gluteal and quadricep muscles. Kasey had mild discomfort upon palpation over both hips but was not so painful as to cease eating her kong. There was mild kyphosis present in the lumbar area and she was slightly painful to deep palpation of the iliocostalis lumborum along the inner bladder line.
Neurological examination revealed mild ataxia of the rear limbs and intact proprioception that was not delayed nor over-responsive. She has appropriate cranial nerve responses.
Problem List:
• Pelvic limb weakness
• Discospondylitis of the lumbar vertebra
• Cervical trigger points
Differential Diagnosis: Differentials of pelvic limb weakness in Kasey can include: degenerative or hereditary issues or neuropathic weakness.
Definitive Diagnosis: Kasey has not had pelvic limb weakness, hip pain, and cervical pain her whole life. This makes her issues more likely a degenerative, age-related, issue. Likely, arthritis is a contributing factor in addition to the weakening of gluteal muscles that is likely because of the hip pain that she is experiencing. She has pain associated with her already diagnosed discospondylosis, causing the kyphosis in the lumbar region of her back. The cervical trigger points are likely because of the weight off-loading that is happening due to the hip pain that Kasey is experiencing. Hip dysplasia is less likely in Kasey since clinical signs of hip dysplasia show up earlier in life and are generally a hereditary issue.
Medical Decision Making: Kasey seems to be experiencing windup pain in the cervical region where she has some areas of actual tense trigger points. She is painful upon manipulation of her hips, likely related to degeneration due to aging or arthritis, and the gluteal muscles are atrophied indicating she is not using her pelvic limbs the way she should be. My goal with acupuncture is to neuromodulate the gluteal muscles and bring in some blood supply to assist with muscle recovery and rehabilitation. I also want to slowly work from periphery to center of the trigger points that are painful in the cervical region. The discospondylitis is causing muscle tension along the bladder line in the lumbar area and acupuncture will be helpful in controlling some of the pain that is associated with this area. Kasey would benefit from dry needling, electroacupuncture, and laser.
Medical acupuncture and Related Techniques Used:
First treatment: 1/21/2019.
– Red Serin coated needles 0.16 x 20mm
– 15 needles placed. I Choose these points so that I could help stimulate the nerves at their origin near the spinal cord. These are also where I felt the muscles were tight and the myofascia wasn’t as mobile as it should be.
o Bilaterally: SI 11, SI 12, BL 11, BL 13, BL 15, BL 18, and BL 19
o BaiHui
– Laser 50hz for 5 minutes along the lumbar/sacral area.
– Manual therapy – firm pressure and manipulation of the trigger points and sore muscles. Patient was VERY loose and myofascia was very loose.
Second Treatment: 2/3/2019
– Attempted to use 0.18mm carbos needles but Kasey was too reactive to them. Went back to Red Serin coated needles
– Red Serin coated needles 0.16mm x 20mm
– 20 reds placed, 3 carbos placed
o Bilaterally: BL 11, BL 13, BL 15, BL 18, BL 19, BL 20, BL 21, BL 22, BL 23
This week I placed more needles and was able to get needles into Kasey more caudally. This will help with pain that she is experiencing in her hips.
o BaiHui (Carbos), YinTang (added to help promote calm behavior)
– Laser 1000hz 1 minute over each trigger point in the latissimus dorsi
– Laser 1000hz 5 minutes over the lumbar and sacral areas and the point of the hip
Third Treatment: 2/7/2019
– Kasey had a great response since the last treatment! She is more active and has actually stopped moaning per her owners. I decided to do the same treatment as last week before trying to put in larger needles again.
– Red Serin coated needles 0.16mm x 20mm, carbos at BaiHui and YinTang
– 20 reds placed, 3 carbos placed
o Bilaterally: BL 11, BL 13, BL 15, BL 18, BL 19, BL 20, BL 21, BL 22, BL 23
o BaiHui (Carbos), YinTang
– Laser 1000hz 1 minute over each trigger point in the latissimus dorsi
– Laser 1000hz 5 minutes over the lumbar and sacral areas and the point of the hip
Fourth Treatment: 2/14/2019
– Used 0.18mm carbos needles and used red needles in the trigger points that were sensitive with the carbos needles. I didn’t place as many needles along the bladder line as I have been because she was calm and only handled this many of the larger needles. I did place some of the carbos more caudally in the gluteal area than I have in the past – she tolerated these really well.
– 15 0.18mm Carbos needles
o Bilaterally: BL 10, BL 13, BL 15, BL 18, BL 19, BL 28, and BL 27.
o BaiHui
– 4 0.16 x 20mm Red Serin coated needles
o Bilaterally: BL 11, and trigger point in cervical region.
– Laser 1000hz 5 minutes over the lumbar and sacral areas and the point of the hip
Outcome/Discussion: Kasey has had a great response to her acupuncture and laser therapies. She is moving more loosely and has stopped moaning according to her owners. I have been acupuncturing her once a week. Her trigger points in the cervical region are still present, but they are much smaller and she is no longer upset when I try to manually manipulate them. She is still a little sensitive to carbos needles being placed near the trigger points, but red serin needles she is tolerating so I am continuing with those for now. I would ultimately like to use electroacupuncture and place needles before and after the trigger point so the current will be running through the trigger point. According to an article written by R. Zhang et al., electroacupuncture can help decrease inflammatory and neuropathic pain. Since Kasey has mild ataxia in her pelvic limbs I think there is some neuropathic involvement and the electroacupuncture would be beneficial to her pain control. Electroacupuncture helps control this pain by activating the body’s endogenous opioid stores. In addition, as a research study done at Indiana University explains, electroacupuncture activates the hypothalamus within 9-22 minutes. This leads to mobilization of stem cells within 2 hours that help promote healing and pain relief. I highly recommend reading this article that summarizes their findings. Knowing this information, I need to save up the funds to buy an electroacupuncture unit and start using it on my patients.
Sources:
1. Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain. R. Zhang, L. Lao, K. Ren, and B. Berman. Anesthesiology. 2014 Feb; 120(2): 482-503.
2. Electroacupuncture Promotes CNS-Dependent Release of Mesenchymal Stem Cells. Tatiana Salazar et. Al. Stem Cells 2017; DOI: 10.1002/stem.2613